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Study: Medicaid expansion may not erode access to care

As the debate over whether to expand Medicaid programs rages on in various state legislatures, a recent JAMA Internal Medicine study gives a partial sigh of relief to those worried that increased Medicaid rolls will mean decreased access to care.

One worry with expanded Medicaid access is that there will not be enough physicians to accept the new enrollees, and that access to care will be more difficult for existing Medicaid patients. To address the concern, researchers from the Yale School of Public Health and the Brown University School of Public Health looked at data from 10 states that expanded Medicaid access between 2000 and 2009, compared to 14 control states that did not have expanded access. Medicaid enrollment increased to 8.8% from 7.2% in the expansion states, and increased to 6.4% from 6.1% in the control states. Overall, the percentage of patients in the expansion states reporting poor access to care dropped to 7.3% from 8.5% before the expansion. The percentage of patients using the emergency department dropped from 41.2% to 40.1%. In control states, poor access to care was steady at 5.3%, and ED use went from 37.3% to 36.1%.

“We found no evidence that expanding the number of individuals eligible for Medicaid coverage eroded perceived access to care or increased the use of emergency services among adult Medicaid enrollees,” the authors concluded.

Certainly a good sign, and of some reassurance to those concerned about the erosion of access to care. But there are still concerns. As pointed out by Mitchell K. Hatz, MD, in a commentary on the study, there are more than just Medicaid patients joining the ranks of the insured; millions of people are gaining insurance through the exchanges. “When people gain insurance, their use of services increases, especially when they first gain insurance, a phenomenon referred to as pent-up demand. With more people seeking care, it may be particularly hard for those with Medicaid, a traditionally poor payer, to find a provider who will see them,” he wrote.